INDIANAPOLIS – A combination of the stimulant drug methylphenidate with a process known as cognitive-behavioral rehabilitation is a promising option to help people who suffer from persistent cognitive problems following traumatic brain injury, researchers at Indiana University School of Medicine have reported.

The study, believed to be the first to systematically compare the combination therapy to alternative treatments, was published online in the journal Neuropsychopharmacology, a Nature publication.

The researchers, led by Brenna McDonald, PsyD, associate professor of radiology and imaging sciences, and Thomas McAllister, MD, chairman of the Department of Psychiatry, compared the effectiveness of two forms of cognitive therapy with and without the use of methylphenidate, a drug used to treat attention-deficit/hyperactivity disorder and better known by its trade name, Ritalin.

“We found that the combination of methylphenidate and Memory and Attention Adaptation Training resulted in significantly better results in attention, episodic and working memory, and executive functioning after traumatic brain injury,” said Dr. McDonald.

In the Memory and Attention Adaptation Training intervention – also used to assist patients with cognitive issues following breast cancer chemotherapy – therapists work with patients to help them develop behaviors and strategies to improve performance in memory and other cognitive tasks. In this study, this “metacognitive” approach was compared with Attention Builders Training, which Dr. McDonald likened to more of a “drill and practice” approach.

The 71 participants who completed the six-week trial were adults who had experienced a traumatic brain injury of at least mild severity – a blow to the head with some alteration of consciousness – at least four months previously, and who either complained of having cognitive problems, or who had been identified with cognitive problems in testing.

The participants were divided into four groups: the two cognitive therapy approaches with the drug therapy, and the two approaches with placebo. After six weeks, the researchers found that participants in the combination metacognitive-Ritalin group improved significantly better in word list learning, nonverbal learning and measures of attention-related and executive function.

However, Dr. McDonald cautioned that due to the relatively small number of participants in the each of the four arms of the trial – 17 to 19 people each – the results of the trial should be considered preliminary.

Nonetheless, she said, the work breaks new ground in providing evidence for the combination therapy.

“There have been a few small studies suggesting methylphenidate could help with attention and executive function after traumatic brain injury, which makes senses because it’s used to improve attention and focus. But this is the first to test it in combination with cognitive-behavioral therapy for treatment in traumatic brain injury,” said Dr. McDonald.

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In addition to Drs. McDonald and McAllister, researchers contributing to the study were Gwen C. Sprehn, Flora M. Hammond, Jaroslaw Harezlak, Li Xing, Rachel N. Wall, and Andrew J. Saykin of the IU School of Medicine; Laura A. Flashman, Carrie L. Kruck, and Karen L. Gillock of the Geisel School of Medicine, Dartmouth College; David B. Arciniegas of the Baylor College of Medicine; Robert J. Ferguson of the Department of Medicine, University of Pittsburgh; Arthur C. Maerlender of the University of Nebraska and Kim Frey of Craig Hospital, Englewood, Colorado.

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (R01 HD047242). Dr. Arciniegas receives research support from the National Institute on Disability, Independent Living, and Rehabilitation Research (H133A120020, H133A130047) and Department of Veterans Affairs (CX000239) and receives compensation from American Psychiatric Association Publishing.

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Abstract

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Abstract

Background. The Arm Motor Ability Test (AMAT) is used to assess and quantify upper-extremity (UE) functional limitation in stroke and other conditions. However, the AMAT score change indicative of important and clinically meaningful change has not been determined.

Objective. To determine the clinically important difference (CID) for the AMAT for individuals with stroke exhibiting mild to moderate hemiparesis.

Methods. A total of 146 chronic stroke survivors exhibiting stable, mild to moderate UE hemiparesis were administered the AMAT before and after interventions targeting their affected UEs. Patients and treating therapists rated perceived amount of UE motor recovery for each participant on a global rating of change (GROC) scale evaluating several facets of UE movement (grasp, release, move the affected UE, perform 5 important functional tasks, overall UE function). Estimated CID of the Functional Ability Scale of the AMAT was calculated using the receiver operating characteristics curve with the GROC scale as the anchor. Distribution-based methods were also used to estimate the CID.

Results. Mean baseline, postintervention, and change in AMAT values for all participants were 3.0 (0.68), 3.3 (0.73), and 0.33 (0.43) respectively. The CID was estimated as an improvement of 0.32 to 0.42 when anchored by the therapist’s perception of improvement and 0.29 to 0.40 when anchored by the patient’s perception of improvement. The CID using distribution-based methods ranged from 0.40 to 0.44.

Conclusions. A change of 0.44 or greater on the AMAT indicates a clinically meaningful improvement in UE functional movements. Clinicians should use this value to determine goals and interpret change scores.

OBJECTIVE: The goal of the study was to assess fatigue in traumatic brain injury patients (TBI), identify potential predictors of its occurrence and its impact on quality of life.
MATERIAL/PATIENTS AND METHODS: We conducted a cross-sectional descriptive study about 25 patients suffering from TBI conducted in the physical medicine and rehabilitation department. The fatigue assessment was performed by two scales: Fatigue Severity Scale (FSS) and EVA Fatigue (EVAF). Depression was evaluated by the HAD scale. Quality of life was assessed by (SF36) scale.
RESULTS: The average age of our patients was 32.19±12.37 with a sex-ratio of 3.5. Thirteen patients (52%) were victims of severe TBI. Fatigue was present in 64% of patients (FSS>36). The mean score calculated by the FSS scale was 42.64±16.43. The mean EVA Fatigue was 5.23±2.32. Depressive symptoms was found in 68% of TBI, 94% of them have expressed fatigue (P=0.01). The average score for quality of life assessed by SF36 was 43.63±15.8. We found a significant correlation between the FSS score and the SF36 score (P<0.01, r=-0.76). Fatigue was more common in males (P=0.01, r=0.53). In addition, fatigue was negatively correlated with the level of education (P=0.03, r=-0.44). However, fatigue was not related to the period length after TBI, the initial GSG score or to the age.
DISCUSSION-CONCLUSION: Fatigue is a persistent symptom after traumatic brain injury. It is often undervalued. Depressive symptoms may be responsible for its appearance. Fatigue had a significant impact on quality of life. The proposal for specific rehabilitation protocols taking into account the aspect of fatigue may be efficient for these patients.

Primary objectives: The main aim of this study was to determine whether the presence of distal lower-limb spasticity had a greater impact on mobility for those who had greater levels of muscle paresis following traumatic brain injury (TBI).

Research design: This was a cross-sectional cohort study of convenience. Seventy-five people attending physiotherapy for mobility limitations following TBI participated in this study. All participants had sustained a moderate–severe TBI and were grouped according to the presence or absence of ankle plantarflexor spasticity for comparison.

Main outcomes and results: The primary outcome measure for mobility was self-selected walking speed and the primary outcome measure for muscle strength was hand-held dynamometry. Secondary outcome measures for mobility and muscle strength were the High-level Mobility Assessment Tool (HiMAT) and ankle power generation (APG) at push-off. Spasticity was quantified with the Modified Tardieu scale. Participants with ankle plantarflexor spasticity (Group 2) had slower self-selected walking speeds. There was no statistically significant effect for Group and plantarflexor strength (p = 0.81).

Conclusion: Although participants with ankle plantarflexor spasticity walked significantly slower than those without, the presence of ankle plantarflexor spasticity did not lead to greater mobility limitations for those who were weak.

In today’s world, wearable devices are progressively being used for the enhancement of the nature of the life of individuals. Human Machine Interface (HMI) has been studied for dominant the mechanical device rehabilitation aids through biosignals like EOG and EMG etc., and so on. EMG signals have been studied in detail due to the occurrence of a definite signal pattern. The current proposal focuses on the advancement of a Wearable Device control by using EMG signals of hand movements for controlling the electronic devices. EMG signals are utilized for the production of the control indicators to develop the device control. Also, an EMG sign procurement framework was produced. To create different control signals relying on the sufficiency and length of time of signal segments, the obtained EMG signals were then prepared for device control.

1. Introduction

1.1 Need for Rehabilitation Techniques

A major a part of our society is littered with one or the opposite reasonably disabilities owing to accidents and neuro-logic disorders. These patients rely upon the members of the family or care takers for his or her day to day activities like quality, communication with atmosphere, mistreatment the home instrumentation, etc1,2.

Rehabilitation devices facilitate the patients with disabilities to measure, work, play or study severally. Moreover, they improve the standard of life led by these individuals and maintain their shallowness.

1.2 EMG based Methods

Electrical potentials generated during muscle contraction are measured by EMG. The contraction of somatic cell takes place once it receives associate degree impulse. The myogram ascertained is that the add of all the action potentials that occur round the conductor site. In most of the cases, the amplitude of the myogram will increase as a result of contraction. Myogram signals is used for a range of applications together with clinical applications, HCI and interactive gaming. They’re non-heritable simply and are comparatively high in magnitude than alternative bio-signals. On the opposite hand, myogram signals area unit simply liable to noise. myogram signals contain difficult styles of noise as a result of inherent instrumentation noise, non-particulate
radiation, motion artifacts, and therefore the interaction of various tissues. Hence, to filter the unwanted noise in myogram, preprocessing is critical3. The myogram signals even have completely different signatures counting on age, muscle development, motor unit ways, skin fat layer, and gesture designs. The external appearances of 2 individuals’ gestures would possibly look identical, however the characteristic myogram signals area unit completely different4.

Discovery brings with it possible implications for brain regeneration –

In a cross-domain study directed by professor Peter Carmeliet (VIB – KU Leuven), researchers discovered unexpected cells in the protective membranes that enclose the brain, the so called meninges. These ‘neural progenitors’ (stem cells that differentiate into different kinds of neurons) are produced during embryonic development.

These findings show that the neural progenitors found in the meninges produce new neurons after birth, highlighting the importance of meningeal tissue as well as these cells’ potential in the development of new therapies for brain damage or neurodegeneration. A paper highlighting the results is published in the journal Cell Stem Cell.

Scientists’ understanding of brain plasticity, or the ability of the brain to grow, develop, recover from injuries and adapt to changing conditions throughout our lives, has been greatly broadened in recent years. Before the discoveries of the last few decades, neurologists once thought that the brain became ‘static’ after childhood. This dogma has changed, with researchers finding more and more evidence that the brain is capable of healing and regenerating in adulthood, thanks to the presence of stem cells. However, neuronal stem cells were generally believed to only reside within the brain tissue, not in the membranes surrounding it.

The meninges: unappreciated no more

Believed in the past to serve a mainly protective function to dampen mechanical shocks, the meninges have been historically underappreciated by science as having neurological importance in its own right. The data gathered by the team challenges the current idea that neural precursors—or stem cells that give rise to neurons—can only be found inside actual brain tissue.

Prof. Peter Carmeliet notes: “The neuronal stems cells that we discovered inside the meninges differentiate to full neurons, electrically-active and functionally integrated into the neuronal circuit. To show that the stem cells reside in the meninges, we used the extremely powerful single-cell RNA sequencing technique, a very novel top-notch technique, capable of identifying the [complex gene expression signature] nature of individual cells in a previously unsurpassed manner, a première at VIB.”

Following up on future research avenues

When it comes to future leads for this discovery, the scientists also see possibilities for translation into clinical application, though future work is required.

“An intriguing question is whether these neuronal stem cells in the meninges could lead to better therapies for brain damage or neurodegeneration. However, answering this question would require a better understanding of the molecular mechanisms that regulate the differentiation of these stem cells,” says Carmeliet. “How are these meningeal stem cells activated to become different kinds of neurons? Can we therapeutically ‘hijack’ their regeneration potential to restore dying neurons in, for example, Alzheimer’ Disease, Parkinson’s Disease, amyotrophic lateral sclerosis (ALS), and other neurodegenerative disorders? Also, can we isolate these neurogenic progenitors from the meninges at birth and use them for later transplantation? These findings open up very exciting research opportunities for the future.”

Moving into unchartered territory is high risk, and can offer high gain, but securing funding for such type of research is challenging. However, Carmeliet’s discoveries were made possible to a large extent by funding through “Opening the Future: pioneering without boundaries”, a recently created Mecenas Funding Campaign for funding of high risk brain research but with potential for breakthrough discoveries, started up by the KU Leuven in 2013 and unique in Flanders.

“Being able to use such non-conventional funding channels is of utmost importance to break new boundaries in research,” says Carmeliet. “This unique Mecenas funding initiative by the KU Leuven is innovative and boundary-breaking by itself. Our entire team is enormously grateful for the opportunities it has created for our investigations”.

Note: Material may have been edited for length and content. For further information, please contact the cited source.

Whilst previous research has detailed the impact of TBI on an individual’s
sexuality, few studies have investigated couples’ sexuality where one partner has sustained a TBI.

The study assessed sexual function in individuals with TBI and their partners. Fifty five individuals who had sustained TBI and their partners completed the Derogatis Interview for Sexual Function-Self Report (DISF-SR). All participants scored below the 50th percentile in relation to norms. Whilst participants with TBI obtained lower T-scores than partners on all subscales (except for sexual behaviour/experiences where scores were equivalent), as well as the total score, none of these differences was significant. Item analysis indicated that female participants with TBI reported significantly lower scores than female partners on frequency of having normal lubrication. Normative comparisons revealed that approximately one-third of individuals with TBI and one-fifth of their partners scored below the second percentile.

Given the high frequency of sexual problems in individuals with TBI, which also impact their partners, addressing sexual problems should be a priority in rehabilitation and beyond.